CHRONIC INTRACTABLE PAIN MANAGEMENT - Codman …

1 Codman 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: Fax: 303-703-1572 CODING SHEETS CHRONIC INTRACTABLE pain MANAGEMENT Effective January 1, 2011 All Medicare payment rates are current as of the time of printing. January 2011 1 The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Codman & Shurtleff, Inc. concerning levels of reimbursement, payment, or charge. Similarly, all CPT AMA and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Codman & Shurtleff, Inc. that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payor.

2 We strongly recommend that you consult your payor organization with regard to its reimbursement policies. Current Procedural Terminology 2010 American Medical Association. All rights reserved. All Medicare payment rates are current as of the time of printing. Codman 3000 Constant-Flow Infusion Pump CHRONIC INTRACTABLE pain MANAGEMENT PHYSICIAN SERVICES 2011 MEDICARE REIMBURSEMENT1 CPT is a trademark of the American Medical Association. Current Procedural Terminology (CPT) is copyright 2010 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. NOTE: Physicians have a code to use for implantable pump refills: 95991 [Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); administered by physician].

3 This code is specific to a physician performing the services, in contrast to 95990 [Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular)] for which a professional other than a physician is expected to perform the services. As with other infusion pump refill and maintenance codes, this code is not payable when performed in an ASC. Note: When performing multiple procedures, review current correct coding guidelines carefully. Services that are considered a component of another procedure cannot always be coded and billed separately. Medicare s Correct Coding Initiative is reviewed and updated several times a year. Commercial payer policies vary and should be consulted and reviewed thoroughly on a regular basis.

4 SCREENING TRIAL2 Code Code Description Medicare Phys Fee Schedule3 Global Days4 Non-Facility (Phys Office) Facility (Non-Phys Office) 62310 Injection, single (not via indwelling catheter), not including neurolytic substances, w/ or w/o contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, other solution), epidural or subarachnoid; cervical or thoracic $ $ 000 62311 Injection, single (not via indwelling catheter), not including neurolytic substances, w/ or w/o contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, other solution), epidural or subarachnoid; lumbar, sacral (caudal) $ $ 000 Non-Tunneled Catheter 62318 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic $ $ 000 62319 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid.

5 Lumbar, sacral (caudal) $ $ 000 Tunneled Catheter 62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; w/o laminectomy Not typically performed in this site of service $ 010 62351 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump w/ laminectomy $ 090 January 2011 2 The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Codman & Shurtleff, Inc. concerning levels of reimbursement, payment, or charge. Similarly, all CPT AMA and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Codman & Shurtleff, Inc.

6 That these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payor. We strongly recommend that you consult your payor organization with regard to its reimbursement policies. Current Procedural Terminology 2010 American Medical Association. All rights reserved. All Medicare payment rates are current as of the time of printing. PHYSICIAN SERVICES (continued) SCREENING TRIAL (continued)2 Code Code Description Medicare Phys Fee Schedule3 Global Days4 Non-Facility (Phys Office) Facility (Non-Phys Office) Other Services 64999 Unlisted procedure, nervous system Carrier Determined 72275 -26* Epidurography, radiological supervision and interpretation $ (Global) $ (-26, Professional)* N/A 72265 -26* Myelography, lumbosacral, radiological supervision and interpretation $ (Global) $ (-26, Professional)* N/A 77003 -26* Fluoroscopic guidance & localization of needle or catheter tip for spine of paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal, epidural, subarchnoid, paravertebral facet joint, paraverterbral facet joint nerve, or sacroiliac joint)

7 , including neurolytic agent destruction $ (Global) $ (-26, Professional)* N/A *Modifier -26 (aka PC) should be used when billing for the professional component of a service. IMPLANTATION OF PUMP5 Code Code Description Medicare Phys Fee Schedule3 Global Days4 Non-Facility (Phys Office) Facility (Non-Phys Office) Implanted Catheter 62350 Implantation, revision or repositioning of tunneled intrathecal or epidural w/o laminectomy Not typically performed in this site of service $ 010 62351 Implantation, revision or repositioning of tunneled intrathecal or epidural laminectomy $ 090 Non-Programmable Pump 62361 Implantation or replacement of device for intrathecal or epidural drug infusion; non-programmable pump $ 010 Programmable Pump 62362 Implantation or replacement of device for intrathecal or epidural drug infusion.

8 Programmable pump, including preparation of pump, with or without programming $ 010 Other Services 76000-26* Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy) $ (-26, Professional)* N/A 76001-26* Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician $ (-26, Professional)* N/A 72265-26* Myelography, lumbosacral, radiological supervision and interpretation $ (-26, Professional)* N/A *Modifier -26 (aka PC) should be used when billing for the professional component of a service. January 2011 3 The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Codman & Shurtleff, Inc. concerning levels of reimbursement, payment, or charge.

9 Similarly, all CPT AMA and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Codman & Shurtleff, Inc. that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payor. We strongly recommend that you consult your payor organization with regard to its reimbursement policies. Current Procedural Terminology 2010 American Medical Association. All rights reserved. All Medicare payment rates are current as of the time of printing. PHYSICIAN SERVICES (continued) REFILL AND MAINTENANCE Code Code Description Medicare Phys Fee Schedule3 Global Days4 Non-Facility (Phys Office) Facility (Non-Phys Office) Non-Programmable Pump Only 64999 Unlisted procedure code, nervous system ( , bolus injections) Carrier Determined Programmable Pump Only 62367 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming $ $ N/A 62368 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status).

10 With reprogramming $ $ N/A Refill and Maintenance of Implanted Pump 95990 Refilling & maintenance of implantable drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); $ $ N/A 95991 Refilling & maintenance of implantable drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); administered by physician $ $ N/A A42206 Refill kit for implantable infusion pump Refer to Carrier-specific policies N/A N/A J2275 -KD7,8 Injection, Morphine Sulfate (preservative free), per 10 mg N/A N/A N/A J3490 -KD7,7 Unclassified Drugs Based on Invoice N/A J7799-KD7,7 NOC drugs, other than inhalation drugs, administered through DME Refer to Carrier-specific policies N/A EXPLANTATION OF PUMP OR CATHETER Code Code Description Medicare Phys Fee Schedule3 Global Days4 Non-Facility (Phys Office) Facility (Non-Phys Office) 62355 Removal of previously implanted intrathecal or epidural catheter $ $ 010 62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion $ $ 010 *Status/Payment Indicator Key: A2= ASC payment based on OPPS rate.